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Research article
Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure
Ann-Kathrin Ozga
University Medical Center Hamburg-Eppendorf
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9501-7301
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Background: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events one year after the first stroke by using the new weighted all-cause hazard ratio.
Methods: This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates.
Results: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2 - 0.9), 0.8 (0.4 - 2.2), 1.3 (0.5 - 2.5), 1.2 (0.3 - 2.7), 1.6 (0.8 - 3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.
Conclusions: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
Keywords
stroke, death, composite endpoint, time-to-event, risk factors, weighted all-cause hazard ratio
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CURRENT STATUS: Under Review
Version 4
Posted 20 May, 2020
No community comments so far
Editor assigned
On 11 May, 2020
Editor invited
On 10 May, 2020
Submission checks complete
On 14 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 08 May, 2020
Review #1 received
Received 05 May, 2020
Reviewer #1 agreed
On 30 Apr, 2020
Reviewers invited
Invitations sent on 21 Apr, 2020
Editor assigned
On 16 Apr, 2020
Submission checks complete
On 15 Apr, 2020
Editor invited
On 15 Apr, 2020
No comments provided
Editorial decision: Major revision
On 23 Mar, 2020
Review #3 received
Received 22 Mar, 2020
Review #2 received
Received 19 Mar, 2020
Review #1 received
Received 18 Mar, 2020
Reviewer #3 agreed
On 10 Mar, 2020
Reviewer #2 agreed
On 06 Mar, 2020
Reviewers invited
Invitations sent on 03 Mar, 2020
Reviewer #1 agreed
On 03 Mar, 2020
Editor assigned
On 02 Mar, 2020
Submission checks complete
On 01 Mar, 2020
Editor invited
On 01 Mar, 2020
No comments provided
Editorial decision: Major revision
On 13 Feb, 2020
Review #3 received
Received 12 Feb, 2020
Reviewer #3 agreed
On 29 Jan, 2020
Review #1 received
Received 08 Jan, 2020
Review #2 received
Received 08 Jan, 2020
Reviewer #2 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 23 Dec, 2019
Reviewer #1 agreed
On 23 Dec, 2019
Editor assigned
On 09 Dec, 2019
Submission checks complete
On 08 Dec, 2019
Editor invited
On 08 Dec, 2019
First submitted
On 05 Dec, 2019
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure
Ann-Kathrin Ozga
University Medical Center Hamburg-Eppendorf
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9501-7301
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 20 May, 2020
No community comments so far
Editor assigned
On 11 May, 2020
Editor invited
On 10 May, 2020
Submission checks complete
On 14 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 08 May, 2020
Review #1 received
Received 05 May, 2020
Reviewer #1 agreed
On 30 Apr, 2020
Reviewers invited
Invitations sent on 21 Apr, 2020
Editor assigned
On 16 Apr, 2020
Submission checks complete
On 15 Apr, 2020
Editor invited
On 15 Apr, 2020
No comments provided
Editorial decision: Major revision
On 23 Mar, 2020
Review #3 received
Received 22 Mar, 2020
Review #2 received
Received 19 Mar, 2020
Review #1 received
Received 18 Mar, 2020
Reviewer #3 agreed
On 10 Mar, 2020
Reviewer #2 agreed
On 06 Mar, 2020
Reviewers invited
Invitations sent on 03 Mar, 2020
Reviewer #1 agreed
On 03 Mar, 2020
Editor assigned
On 02 Mar, 2020
Submission checks complete
On 01 Mar, 2020
Editor invited
On 01 Mar, 2020
No comments provided
Editorial decision: Major revision
On 13 Feb, 2020
Review #3 received
Received 12 Feb, 2020
Reviewer #3 agreed
On 29 Jan, 2020
Review #1 received
Received 08 Jan, 2020
Review #2 received
Received 08 Jan, 2020
Reviewer #2 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 23 Dec, 2019
Reviewer #1 agreed
On 23 Dec, 2019
Editor assigned
On 09 Dec, 2019
Submission checks complete
On 08 Dec, 2019
Editor invited
On 08 Dec, 2019
First submitted
On 05 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events one year after the first stroke by using the new weighted all-cause hazard ratio.
Methods: This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates.
Results: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2 - 0.9), 0.8 (0.4 - 2.2), 1.3 (0.5 - 2.5), 1.2 (0.3 - 2.7), 1.6 (0.8 - 3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.
Conclusions: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
Figure 1
Figure 2
Figure 3
Figure 4